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Journal of Neurology Mar 2022Persistent Postural-Perceptual Dizziness (PPPD) is one of the most common types of chronic dizziness. The pathogenesis remains unclear. (Review)
Review
BACKGROUND
Persistent Postural-Perceptual Dizziness (PPPD) is one of the most common types of chronic dizziness. The pathogenesis remains unclear.
OBJECTIVE
This study aimed to systematically review neuroimaging literature for investigating the central mechanism of PPPD and related disorders.
METHODS
PubMed, EMBASE, Medline, Cochrane, and Web of Science were searched by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The articles analyzing structural and functional neuroimaging features of PPPD and related disorders were selected according to eligibility criteria.
RESULTS
Fifteen articles, including 4 structural, 10 functional, and 1 multimodal imaging, were eligible for inclusion in this review. The whiter matter alterations in PPPD are not entirely consistent. The changes of grey matter mainly in multisensory vestibular cortices, visual cortex, cerebellum, as well as anxiety-related network. Consistent with structural imaging, functional imaging conducted during the specific tasks or in the resting state has both found abnormal functional activation and connectivity in the vestibular cortex, especially in the parieto-insular vestibular cortex (PIVC), visual cortex, cerebellum, and anxiety-related network in PPPD and related disorder.
CONCLUSIONS
The current review provides up-to-date knowledge and summarizes the possible central mechanism for PPPD and related disorders, and it is helpful to understanding the mechanism of PPPD.
Topics: Cerebral Cortex; Dizziness; Gray Matter; Humans; Mental Disorders; Neuroimaging
PubMed: 34019178
DOI: 10.1007/s00415-021-10558-x -
The Cochrane Database of Systematic... Nov 2020Stroke is one of the leading causes of disability worldwide. Functional impairment, resulting in poor performance in activities of daily living (ADL) among stroke... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Stroke is one of the leading causes of disability worldwide. Functional impairment, resulting in poor performance in activities of daily living (ADL) among stroke survivors is common. Current rehabilitation approaches have limited effectiveness in improving ADL performance, function, muscle strength, and cognitive abilities (including spatial neglect) after stroke, with improving cognition being the number one research priority in this field. A possible adjunct to stroke rehabilitation might be non-invasive brain stimulation by transcranial direct current stimulation (tDCS) to modulate cortical excitability, and hence to improve these outcomes in people after stroke.
OBJECTIVES
To assess the effects of tDCS on ADL, arm and leg function, muscle strength and cognitive abilities (including spatial neglect), dropouts and adverse events in people after stroke.
SEARCH METHODS
We searched the Cochrane Stroke Group Trials Register, CENTRAL, MEDLINE, Embase and seven other databases in January 2019. In an effort to identify further published, unpublished, and ongoing trials, we also searched trials registers and reference lists, handsearched conference proceedings, and contacted authors and equipment manufacturers.
SELECTION CRITERIA
This is the update of an existing review. In the previous version of this review, we focused on the effects of tDCS on ADL and function. In this update, we broadened our inclusion criteria to compare any kind of active tDCS for improving ADL, function, muscle strength and cognitive abilities (including spatial neglect) versus any kind of placebo or control intervention.
DATA COLLECTION AND ANALYSIS
Two review authors independently assessed trial quality and risk of bias, extracted data, and applied GRADE criteria. If necessary, we contacted study authors to ask for additional information. We collected information on dropouts and adverse events from the trial reports.
MAIN RESULTS
We included 67 studies involving a total of 1729 patients after stroke. We also identified 116 ongoing studies. The risk of bias did not differ substantially for different comparisons and outcomes. The majority of participants had ischaemic stroke, with mean age between 43 and 75 years, in the acute, postacute, and chronic phase after stroke, and level of impairment ranged from severe to less severe. Included studies differed in terms of type, location and duration of stimulation, amount of current delivered, electrode size and positioning, as well as type and location of stroke. We found 23 studies with 781 participants examining the effects of tDCS versus sham tDCS (or any other passive intervention) on our primary outcome measure, ADL after stroke. Nineteen studies with 686 participants reported absolute values and showed evidence of effect regarding ADL performance at the end of the intervention period (standardised mean difference (SMD) 0.28, 95% confidence interval (CI) 0.13 to 0.44; random-effects model; moderate-quality evidence). Four studies with 95 participants reported change scores, and showed an effect (SMD 0.48, 95% CI 0.02 to 0.95; moderate-quality evidence). Six studies with 269 participants assessed the effects of tDCS on ADL at the end of follow-up and provided absolute values, and found improved ADL (SMD 0.31, 95% CI 0.01 to 0.62; moderate-quality evidence). One study with 16 participants provided change scores and found no effect (SMD -0.64, 95% CI -1.66 to 0.37; low-quality evidence). However, the results did not persist in a sensitivity analysis that included only trials with proper allocation concealment. Thirty-four trials with a total of 985 participants measured upper extremity function at the end of the intervention period. Twenty-four studies with 792 participants that presented absolute values found no effect in favour of tDCS (SMD 0.17, 95% CI -0.05 to 0.38; moderate-quality evidence). Ten studies with 193 participants that presented change values also found no effect (SMD 0.33, 95% CI -0.12 to 0.79; low-quality evidence). Regarding the effects of tDCS on upper extremity function at the end of follow-up, we identified five studies with a total of 211 participants (absolute values) without an effect (SMD -0.00, 95% CI -0.39 to 0.39; moderate-quality evidence). Three studies with 72 participants presenting change scores found an effect (SMD 1.07; 95% CI 0.04 to 2.11; low-quality evidence). Twelve studies with 258 participants reported outcome data for lower extremity function and 18 studies with 553 participants reported outcome data on muscle strength at the end of the intervention period, but there was no effect (high-quality evidence). Three studies with 156 participants reported outcome data on muscle strength at follow-up, but there was no evidence of an effect (moderate-quality evidence). Two studies with 56 participants found no evidence of effect of tDCS on cognitive abilities (low-quality evidence), but one study with 30 participants found evidence of effect of tDCS for improving spatial neglect (very low-quality evidence). In 47 studies with 1330 participants, the proportions of dropouts and adverse events were comparable between groups (risk ratio (RR) 1.25, 95% CI 0.74 to 2.13; random-effects model; moderate-quality evidence). AUTHORS' CONCLUSIONS: There is evidence of very low to moderate quality on the effectiveness of tDCS versus control (sham intervention or any other intervention) for improving ADL outcomes after stroke. However, the results did not persist in a sensitivity analyses including only trials with proper allocation concealment. Evidence of low to high quality suggests that there is no effect of tDCS on arm function and leg function, muscle strength, and cognitive abilities in people after stroke. Evidence of very low quality suggests that there is an effect on hemispatial neglect. There was moderate-quality evidence that adverse events and numbers of people discontinuing the treatment are not increased. Future studies should particularly engage with patients who may benefit the most from tDCS after stroke, but also should investigate the effects in routine application. Therefore, further large-scale randomised controlled trials with a parallel-group design and sample size estimation for tDCS are needed.
Topics: Activities of Daily Living; Adult; Aged; Bias; Cognition Disorders; Confidence Intervals; Female; Humans; Lower Extremity; Male; Middle Aged; Motor Activity; Muscle Strength; Patient Dropouts; Perceptual Disorders; Randomized Controlled Trials as Topic; Recovery of Function; Stroke Rehabilitation; Transcranial Direct Current Stimulation; Upper Extremity
PubMed: 33175411
DOI: 10.1002/14651858.CD009645.pub4 -
Schizophrenia Research Feb 2020Voice atypicalities have been a characteristic feature of schizophrenia since its first definitions. They are often associated with core negative symptoms such as flat... (Meta-Analysis)
Meta-Analysis Review
Voice atypicalities have been a characteristic feature of schizophrenia since its first definitions. They are often associated with core negative symptoms such as flat affect and alogia, and with the social impairments seen in the disorder. This suggests that voice atypicalities may represent a marker of clinical features and social functioning in schizophrenia. We systematically reviewed and meta-analyzed the evidence for distinctive acoustic patterns in schizophrenia, as well as their relation to clinical features. We identified 46 articles, including 55 studies with a total of 1254 patients with schizophrenia and 699 healthy controls. Summary effect sizes (Hedges'g and Pearson's r) estimates were calculated using multilevel Bayesian modeling. We identified weak atypicalities in pitch variability (g = -0.55) related to flat affect, and stronger atypicalities in proportion of spoken time, speech rate, and pauses (g's between -0.75 and -1.89) related to alogia and flat affect. However, the effects were mostly modest (with the important exception of pause duration) compared to perceptual and clinical judgments, and characterized by large heterogeneity between studies. Moderator analyses revealed that tasks with a more demanding cognitive and social component showed larger effects both in contrasting patients and controls and in assessing symptomatology. In conclusion, studies of acoustic patterns are a promising but, yet unsystematic avenue for establishing markers of schizophrenia. We outline recommendations towards more cumulative, open, and theory-driven research.
Topics: Aphasia; Bayes Theorem; Humans; Schizophrenia; Speech; Voice
PubMed: 31839552
DOI: 10.1016/j.schres.2019.11.031 -
Autism Research : Official Journal of... Apr 2021According to a recent influential proposal, several phenotypic features of autism spectrum disorder (ASD) may be accounted for by differences in predictive skills... (Review)
Review
According to a recent influential proposal, several phenotypic features of autism spectrum disorder (ASD) may be accounted for by differences in predictive skills between individuals with ASD and neurotypical individuals. In this systematic review, we describe results from 47 studies that have empirically tested this hypothesis. We assess the results based on two observable aspects of prediction: learning a pairing between an antecedent and a consequence and responding to an antecedent in a predictive manner. Taken together, these studies suggest distinct differences in both predictive learning and predictive response. Studies documenting differences in learning predictive pairings indicate challenges in detecting such relationships especially when predictive features of an antecedent have low salience or consistency, and studies showing differences in habituation and perceptual adaptation suggest low-level predictive processing differences in ASD. These challenges may account for the observed differences in the influence of predictive priors, in spontaneous predictive movement or gaze, and in social prediction. An important goal for future research will be to better define and constrain the broad domain-general hypothesis by testing multiple types of prediction within the same individuals. Additional promising avenues include studying prediction within naturalistic contexts and assessing the effect of prediction-based intervention on supporting functional outcomes for individuals with ASD. LAY SUMMARY: Researchers have suggested that many features of autism spectrum disorder (ASD) may be explained by differences in the prediction skills of people with ASD. We review results from 47 studies. These studies suggest that ASD may be associated with differences in the learning of predictive pairings (e.g., learning cause and effect) and in low-level predictive processing in the brain (e.g., processing repeated sounds). These findings lay the groundwork for research that can improve our understanding of ASD and inform interventions. Autism Res 2021, 14: 604-630. © 2021 International Society for Autism Research and Wiley Periodicals LLC.
Topics: Autism Spectrum Disorder; Autistic Disorder; Brain; Humans; Learning; Motivation
PubMed: 33570249
DOI: 10.1002/aur.2482 -
Journal of Speech, Language, and... Jun 2022Assessment of resonance characteristics is essential in research and clinical practice in individuals with velopharyngeal impairment. The purpose of this study was to...
INTRODUCTION
Assessment of resonance characteristics is essential in research and clinical practice in individuals with velopharyngeal impairment. The purpose of this study was to systematically review correlations between auditory-perceptual ratings and nasalance scores obtained by a nasometer in individuals with resonance disorders and to identify factors that affected the correlations between these two measures.
METHOD
Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a systematic search was conducted for studies reporting a correlation between nasality ratings and nasalance scores using six electronic databases based on predefined inclusion and exclusion criteria.
RESULTS
A total of 27 studies were included in this systematic review. Characteristics of study components including participants, types of assessment and stimuli, correlation coefficients, and reliability values of each study were identified, and a narrative synthesis was conducted. The methodological quality of each study was also appraised. The correlation level between nasalance values and nasality ratings varied from nonsignificant to strong ( = .92). The quality rating scores of the selected studies ranged from 44% to 94%, with an average score of 75%.
DISCUSSION
Factors that did or did not affect the varied correlation between nasality ratings and nasalance scores were discussed. Speech stimuli and the listeners' background were associated with correlations between the two measures. In addition, the sex of the speakers could be a factor affecting its correlation. However, the types of perceptual scales and listening conditions did not influence its correlations between the two measures.
SUPPLEMENTAL MATERIAL
https://doi.org/10.23641/asha.19653207.
Topics: Dysphonia; Humans; Nose; Reproducibility of Results; Speech Disorders; Speech Production Measurement; Voice Quality
PubMed: 35500290
DOI: 10.1044/2022_JSLHR-21-00588 -
International Journal of Language &... May 2022Acquired brain injury (ABI), especially to the right hemisphere, can result in difficulty using or understanding prosodic contours in speech. Prosody is used to convey... (Review)
Review
BACKGROUND
Acquired brain injury (ABI), especially to the right hemisphere, can result in difficulty using or understanding prosodic contours in speech. Prosody is used to convey emotional connotation or linguistic intent and includes pitch, loudness, rate, and voice quality. A disorder in the comprehension or production of prosody is known as aprosodia; despite the communication disability caused by prosodic disorders, the assessment and treatment of aprosodia following ABI has received scant attention.
AIMS
The aim of this scoping review is to gather and synthesise useful knowledge on aprosodia and provide therapists with an exhaustive document in order to guide clinical decision-making encouraging active identification and treatment of this disorder.
METHODS & PROCEDURES
This scoping review, conducted in accordance with PRISMA-ScR guidelines, investigated the existing literature concerning the assessment and treatments of linguistic and affective aprosodia in adult patients after ABI. A systematic search in four electronic databases (PubMed, CINAHL, Web of Science, ScienceDirect) was conducted for articles written in English, French, or Italian published between 1970 and 2020. After all evaluative criteria were applied, 15 articles were included for final review.
OUTCOMES & RESULTS
Results show the presence of six assessment tools for affective aprosodia and five evaluation tools targeting affective and linguistic prosody. Assessment of aprosodia is generally accomplished through acoustic and perceptual approaches. Current treatments for prosodic disorders focus on expressive aprosodia and have applied mostly two different approaches: imitative and cognitive-linguistic methods.
CONCLUSION & IMPLICATIONS
Findings suggest that aprosodia can be assessed by therapists through various techniques and may be amenable to behavioural treatments. Nevertheless, although there are several assessment tools available, no one currently offers a comprehensive assessment that incorporates an ecological dimension. It therefore seems necessary to continue research in this direction. The rehabilitation of receptive prosody abilities also remains to be explored.
WHAT THIS PAPER ADDS
What is already known on the subject Prosody has a fundamental role in communication and conveys speakers' intentions and emotions. Therefore, a deficit of prosody (aprosodia) after acquired brain injury can reduce social participation and engagement. Assessment tools and rehabilitation treatments are necessary in order to improve this disorder and patients' quality of life. What this paper adds to existing knowledge The evaluation tools currently available focuses mostly on affective aprosodia, whereas the linguistic prosody is less assessed. There exist two treatments for expressive aprosodia: motoric-imitative and cognitive-linguistic treatments; however, their efficacy is tested on small groups of patients. No treatments targeting receptive aprosodia were found. What are the potential or actual clinical implications of this work? We need more sensitive and reliable tools and systematic evaluations of all the components of prosody (affective and linguistic, receptive and expressive prosody). We need researches who analyse bigger samples of patients after right hemisphere brain injury and we identified the need of more well-designed studies and better understanding of the pathophysiology of aprosodia.
Topics: Adult; Brain Injuries; Emotions; Humans; Linguistics; Quality of Life; Speech Disorders
PubMed: 34967993
DOI: 10.1111/1460-6984.12692 -
Psychiatry and Clinical Neurosciences May 2022Source monitoring (SM) is the metacognitive ability to determine the origin of one's experiences. SM is altered in primary psychiatric psychosis, although relationships... (Meta-Analysis)
Meta-Analysis Review
AIMS
Source monitoring (SM) is the metacognitive ability to determine the origin of one's experiences. SM is altered in primary psychiatric psychosis, although relationships between SM subtypes, other cognitive domains and symptoms are unclear. Our aims were to synthesize evidence comparing psychosis -with and without hallucinations- and healthy controls classifying SM subtypes by source discrimination (internal/external/reality monitoring) and stimulus modality (visual/auditory/imagined/performed).
METHODS
This systematic review adopted Preferred Reporting Items for Systematic Reviews and Meta-Analyses, Meta-analyses Of Observational Studies in Epidemiology and Population, Intervention, Comparison and Outcomes guidelines. Core demographical and clinical parameters were extracted. Newcastle-Ottawa Scale was used as quality check. SM differences between (i) psychosis patients versus healthy controls and (ii) patients with versus without hallucinations were investigated via random-effect model meta-analysis. The primary effect size measure was standardized mean difference (SMD) in each SM subtype performance (error or accuracy). Heterogeneity, publication biases and meta-regressions were assessed.
RESULTS
Five thousand two hundred and fifty-six records were screened to finally include 44 studies (1566 patients, 1175 controls). Mean Newcastle-Ottawa score was 7.41 out of 9. Few studies measured SM associations with cognition (n = 9) and symptoms (n = 19), with heterogeneous findings. SM performance across all measures was reduced in psychosis versus healthy controls (SMD = 0.458). Internal SM (SMD: errors = 0.513; accuracy = 0.733) and imagined stimuli (SMD: errors = 0.688; accuracy = 0.978) were specifically impaired. Patients with versus without hallucinations showed SM deficits only for externalizing (SMD = 0.410) and imagined/auditory (SMD = 0.498/0.277) errors.
CONCLUSION
The proposed classifications highlight specific SM deficits for internal/imagined stimuli in psychosis, providing evidence-based indications to design and interpret future studies.
Topics: Cognition; Hallucinations; Humans; Metacognition; Psychotic Disorders
PubMed: 35124869
DOI: 10.1111/pcn.13338 -
Eating and Weight Disorders : EWD Aug 2023Educational interventions are a key element in the care of young patients with feeding and eating disorders, forming part of the majority of therapeutic approaches. The... (Review)
Review
BACKGROUND
Educational interventions are a key element in the care of young patients with feeding and eating disorders, forming part of the majority of therapeutic approaches. The aim of this review is to evaluate the impact of educational interventions in adolescents with feeding and eating disorders.
METHODS
Following the PRISMA recommendations electronic databases were searched up to 29 June 2023. Studies related to educational interventions in young population diagnosed with feeding and eating disorders (anorexia nervosa, avoidant/restrictive food intake disorder, bulimia nervosa, pica and ruminative disorders and binge- eating disorder) in Spanish and English language, without temporal limitation, were located in the databases: PubMed, Scopus, CINAHL, Cochrane Library, PsycINFO, CUIDEN, DIALNET, and ENFISPO. A search in the databases of grey literature was performed in OpenGrey and Teseo. The review protocol was registered in PROSPERO (CRD42020167736).
RESULTS
A total of 191 articles were selected from the 9744 citations screened. Ten publications were included. The results indicated variability between educational programs, including individual and group interventions, learning techniques and various research methodologies. Variables such as learning, attitudinal and perceptual changes, anthropometric parameters, symptom improvement, normalization of eating patterns, evaluation of the program and cognitive flexibility were identified. The risk of bias was high due to the low methodological quality of a large number of studies analyzed.
CONCLUSION
The results indicate that educational interventions can influence the improvement of knowledge level and have a positive effect on health outcomes. Although education is a common practice in the treatment of these pathologies, high-quality studies were not identified. Thus, this review concludes that additional evidence is needed to evaluate the effectiveness of educational programs, with further research studies, especially randomized controlled trials, to confirm these results.
LEVEL OF EVIDENCE
Level I: Systematic review.
Topics: Humans; Adolescent; Feeding and Eating Disorders; Anorexia Nervosa; Avoidant Restrictive Food Intake Disorder; Binge-Eating Disorder; Bulimia Nervosa
PubMed: 37608142
DOI: 10.1007/s40519-023-01594-9 -
International Journal of Pediatric... Dec 2020Aim of this review is to evaluate the relation between reflux (either laryngopharyngeal or gastroesophageal) and dysphonia in children. (Review)
Review
OBJECTIVE
Aim of this review is to evaluate the relation between reflux (either laryngopharyngeal or gastroesophageal) and dysphonia in children.
DATA SOURCES
PubMed, Scopus, Embase.
REVIEW METHODS
A literature search was conducted over a period from January 1990 to March 2020. The following search words were used either individually or in combination: voice disorders, laryngopharyngeal reflux, and gastroesophageal reflux. The search was conducted over a period of a month: April 2020.
RESULTS
Five clinical research were selected based on our objectives and selection criteria. Four studies were of level III evidence. Altogether, a total of 606 patients were pooled with male predominance of 63%. In all studies, reflux was suggested to have strong relation with dysphonia. Majority of cases used 24-h pH monitoring to confirm reflux which yielded positive results in 69%. The top three most common endoscopic findings include: interarytenoid erythema and edema (32/38), vocal cord erythema and edema (160/231) and postglottic edema (141/337). Vocal cord nodules were found in 28% of our patients. Acoustic analysis and perceptual assessment of voice was performed in only 1 study. No complication from any procedure was mentioned in any of the studies. Outcome of treatment was mentioned in 1 study, whereby after 4.5 months of follow-up, 68% of children showed improvement in symptoms.
CONCLUSION
Current evidence shows that there is strong relation between reflux and dysphonia in children. Most common laryngoscopic findings suggestive of reflux includes interarytenoid erythema and edema, vocal cord erythema and edema and postglottic edema.
Topics: Child; Dysphonia; Hoarseness; Humans; Laryngopharyngeal Reflux; Laryngoscopy; Male; Vocal Cords
PubMed: 33137676
DOI: 10.1016/j.ijporl.2020.110473 -
Frontiers in Neuroscience 2021Hallucinogen-persisting perception disorder (HPPD) features as a diagnostic category in the DSM-5, ICD-11, and other major classifications, but our knowledge of the...
Hallucinogen-persisting perception disorder (HPPD) features as a diagnostic category in the DSM-5, ICD-11, and other major classifications, but our knowledge of the phenomenology of the perceptual symptoms involved and the changes in consciousness during the characteristic "flashbacks" is limited. We systematically evaluated original case reports and case series on HPPD to define its phenomenology, associated (psycho)pathology, and course. Our search of PubMed and Embase yielded 66 relevant publications that described 97 people who, together, experienced 64 unique symptoms of HPPD. Of these, 76% concerned symptoms characteristic of Alice in Wonderland syndrome, over 50% non-visual symptoms, and 38% perceptual symptoms not clearly linked to prior intoxication states. This is in contrast with the DSM-5 diagnostic criteria for HPPD. Even though less than half of the patients showed a protracted disease course of over a year, a third achieved remission. However, in patients with co-occurring depression (with or without anxiety) HPPD symptoms persisted longer and treatment outcomes were more often negative. Thus, unlike the acute stages of psychedelic drug intoxication, which may be accompanied by altered states of consciousness, HPPD is rather characterized by changes in the of consciousness and an attentional shift from exogenous to endogenous phenomena. Since HPPD is a more encompassing nosological entity than suggested in the DSM-5, we recommend expanding its diagnostic criteria. In addition, we make recommendations for clinical practice and future research.
PubMed: 34456666
DOI: 10.3389/fnins.2021.675768